Provider Demographics
NPI:1285959817
Name:MID-COUNTY HEMATOLOGY AND ONCOLOGY, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:MID-COUNTY HEMATOLOGY AND ONCOLOGY, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-735-1155
Mailing Address - Street 1:1201 E OCEAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7082
Mailing Address - Country:US
Mailing Address - Phone:805-735-1155
Mailing Address - Fax:805-735-1133
Practice Address - Street 1:1201 E OCEAN AVE STE B
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7082
Practice Address - Country:US
Practice Address - Phone:805-735-1155
Practice Address - Fax:805-735-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-07
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE652AMedicare PIN